Sevil Bilgin

Functional mobility, depressive symptoms, level of independence, and quality of life of the elderly living at home and in the nursing home.

OBJECTIVES To compare functional mobility, depressive symptoms, level of independence, and quality of life of the elderly living at home and in the nursing home. DESIGN A prospectively designed, comparative study. SETTING A nursing home and a university hospital department. PARTICIPANTS In this study, 33 elderly living in a nursing home and 25 elderly living at home, who fulfilled the inclusion criteria and volunteered to participate, were included. MEASUREMENTS Sociodemographic characteristics were recorded. Functional mobility (Timed Up & Go Test), depressive symptoms (Geriatric Depression Scale), level of independence (Kahoku Aging Longitudinal Study Scale), and quality of life (Visual Analogue Scale) scores were compared between the groups. RESULTS Functional mobility and independence level of the nursing home residents were higher than the home-dwelling elderly (95% CI: -4.88, -0.29 and 0.41, 6.30, respectively), but they had more depressive symptoms (95% CI: 0.30, 5.45), and their level of QoL was lower (95% CI: -15.55, -2.93). CONCLUSION These findings are thought to be important and of benefit for health care professionals and caregivers as indicating the areas that need to be supported for the elderly living at home (functional mobility and independence) and in the nursing home (depressive symptoms and quality of life).

Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury

Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.

Effects of exercise and electrical stimulation on lumbar stabilization in asymptomatic subjects: A comparative study

BACKGROUND AND OBJECTIVES Segmental stabilization training and electrical stimulation are used as a treatment for patients with low back pain. There is limited information on the efficacy of two interventions in the literature. In this study, the efficacy of the two interventions on the multifidus muscle activation and fatigue, segmental stabilization training and electrical stimulation, were examined and compared. MATERIAL AND METHODS Our sample consists of 30 asymptomatic individuals, randomly assigned to one of three groups: the group that was given segmental stabilization training, the group that was given electrical stimulation and the control group that received no treatment. The muscle activity and fatigability of the multifidus were recorded by the surface electromyography before and after the intervention. RESULTS No difference is detected for any of the multifidus muscle activation and fatigue characteristics either within or between groups. CONCLUSION Both techniques did not improve multifidus activation capacity. An effort at submaximal and maximal level affects and increases the activity of multifidus.

Functional contributors to poor movement and balance control in patients with low back pain: A descriptive analysis.

BACKGROUND Automatic and voluntary body position control is essential for postural stability; however, little is known about individual factors that impair the sensorimotor system associated with low back pain (LBP). OBJECTIVE To evaluate automatic and voluntary motor control impairments causing postural instability in patients with LBP. METHODS Motor control impairments associated with poor movement and balance control were analyzed prospectively in 32 patients with LBP. Numeric Rating Scale (NRS) for pain assessment, Oswestry Disability Index (ODI) for disability measurement, and computerized dynamic posturography (CDP) for analysis of postural responses were used to measure outcomes of all patients. Computerized dynamic posturography tests including Sensory organization test (SOT), limits of stability test (movement velocity, directional control, endpoint, and maximum excursion), rhythmic weight shift (rhythmic movement speed and directional control), and adaptation test (toes-up and toes-down tests) were performed and the results compared with NeuroCom normative data. RESULTS The mean age of the patients was 40.50 ± 12.28 years. Lower equilibrium scores were observed in SOT (p < 0.05). There was a significant increase in reaction time and decrease in movement velocity, directional control, and endpoint excursion (p < 0.05). Speed of rhythmic movement along the anteroposterior direction decreased, while speed increased along the lateral direction (p < 0.05). Poor directional control was recorded in the anteroposterior direction (p < 0.05). Toes-down test showed an increased COG sway in patients compared with that in the controls (p < 0.05). CONCLUSIONS LBP causes poor voluntary control of body positioning, a reduction in movement control, delays in movement initiation, and a difficulty to adapt to sudden surface changes.

Early rehabilitation improves neurofunctional outcome after surgery in children with spinal tumors

To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in children with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients (1–17 years old) who received spinal tumor surgical removal. The peddiatric patients received rahabilitation treatment at 4 (range, 2–7) days after surgery for 10 (range, 7–23) days. Results from the Modified McCormick Scale, Functional Independence Measure for Children, American Spinal Injury Association Impairment Scale and Karnofsky Performance Status Scale demonstrated that the sensory function, motor function and activity of daily living of pediatric children who received early rehabilitation were significantly improved. Results also showed that tumor setting and level localization as well as patientss clinical symptoms have no influences on neurofunctional outcomes.

Proprioceptive Rehabilitation After Spine Injury and Surgery

Spine plays an important role in generating proprioceptive input impulse. Proprioceptive inputs provide sensation of movement and posture. The important effects of the spine elements on proprioception, joint position, kinesthesia, functional movement, and posture are well known. The possible alterations in proprioception after spine injury, surgery, and rehabilitation are discussed in details in this chapter.

A comparison of occupational groups using different working postures in terms of their low back and neck health status

OBJECTIVE To compare how disability, fear of movement, psychosocial status and quality of life are affected in terms of low back-neck health status in three occupational groups using different work postures. METHOD Three hundred thirty-nine individuals participated in this study from the following three different occupational groups: group A, where the individuals worked in a prolonged sitting position (secretaries), group B, where the individuals performed dynamic activities in a standing position (cleaning workers) and group C, where the individuals worked in a prolonged standing position (private security officers). The participants were evaluated by Million Visual Analog Scale, Neck Disability Index, Oswestry Disability Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale and Tampa Kinesiophobia Scale. RESULTS It was found that disability, emotional status and the quality of life were minimally affected, but kinesiophobia was increased in all of the occupational groups. In the group C, low back pain disability, quality of life and fear of movement were more affected than the other groups (p< 0.05). CONCLUSION For the occupational groups with long working years, the presence of kinesiophobia should be considered and cognitive-behavioural treatment methods should be recommended. In cleaning workers, low back pain is an important risk factor. Therefore, its awareness should be increased, and preventive programmes should be offered.

The effect of stabilization exercises on diaphragm muscle thickness and movement in women with low back pain

BACKGROUND Diaphragm is an important component of spinal stability. In presence of low back pain, there may be some alterations in this muscle like other muscles that are responsible for lumbal stabilization. OBJECTIVE This study aims to assess the effects of stabilization exercises on diaphragm muscle thickness and motion along with lumbopelvic stability. METHODS Twenty-one women with low back pain participated in the study. Stabilization exercises including motor control training were performed on treatment group (n= 11). In control group (n= 10), strentghening exercises were peformed for back muscles, abdominal muscles and hip muscles. The patients underwent a total of 30 sessions of treatment, 3 days in a week for 10 weeks. The diaphragm muscle thickness and motion was evaluated using ultrasound (US), and lumbopelvic stability was evaluated using lumbopelvic stability tests. RESULTS After the treatment, in the treatment group, increase in diaphragm thickness and improvement in lumbopelvic stability were statically significant (p< 0.05). However, there were no significant changes in diaphragm motion in both groups (p> 0.05). CONCLUSIONS As a result, stabilization exercises increase diaphragm muscle thickness and improve lumbopelvic stability in women with low back pain. Therefore, stabilization exercises should be considered as a part of the treatment program in low back pain.

P187 – 2850: Demographic characteristics and results of rehabilitation of child patients with brain tumors

Objective Our study is a retrospective study, was carried out to determine the demographic characteristics and acute rehabilitation results of patients diagnosed child patients with brain tumors, admitted between the years 2004–2014 at Hacettepe University, Neurosurgery. Methods Demographics and tumour characteristics of 45 child patients admitted to hospital with a diagnosis of brain tumor was recorded. Duration of hospital stay and rehabilitation of the patients were determined. Effectiveness of rehabilitation was evaluated by Karnofsky performance scale and Gross Motor Function Scale (GMFCS), Pediatric Functional Independent Scale (WeeFIM) before and after treatment. Results 45 study patients, 18 (%40) women and 27 (%60) men, have brain tumors. The mean age was 9.2±4.5 years. The duration of hospital stay and rehabilitation of patients 28.38±15.1 and 17.20±10.8 days. Gains that were observed in Karnofsky performances scores, WeeFIM and GMFCS of patients with brain tumors before and after treatment, was statistically significant (p Conclusion Children with brain tumors, with a high percentage of mortality and morbidity is an important health problem with increasing frequency with each passing day. In our study, effectiveness of rehabilitation as from the early period of brain tumor patients was demonstrated. Finally, children patients with brain tumors must be rehabilitated since the early period and be targeted the return of patients maximal functional level.

Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization.

Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1, Hunt and Hess grade ≤ II and surgical clipping; Group 2, Hunt and Hess grade ≤ II and endovascular embolization; Group 3, Hunt and Hess grade ≥ III and surgical clipping; Group 4, Hunt and Hess grade ≥ III and endovascular embolization. Level of consciousness was evaluated using the Glasgow Coma Scale, functional status using the Glasgow Outcome Scale, level of the mobility using the Mobility Scale for acute stroke patients, and independence in activities of daily living using the Barthel Index. After early physiotherapy, the level of consciousness and functional status improved significantly in Groups 1, 3, and 4; mobility improved significantly in all groups; and independence in activities of daily living improved significantly in Groups 1 and 3. At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4. Level of consciousness, functional status, mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients with a worse clinical status at presentation had a poorer functional status at discharge. The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm.